Individual
AMY M SISTRUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 21ST AVE SW APT L3, TUMWATER, WA 98512-5688
(253) 441-9163
Mailing address
3300 21ST AVE SW APT L3, TUMWATER, WA 98512-5688
(253) 441-9163
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00019264
WA
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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